Kamath K Annappa, Pothy Vasudevan S, Pandey Himanshu
Department of Urology, Government Medical College, Thiruvananthapuram, Kerala, India.
Indian J Urol. 2023 Jul-Sep;39(3):202-208. doi: 10.4103/iju.iju_66_23. Epub 2023 Jun 30.
RENAL nephrometry score (RNS) is a standardized system to grade the complexity of renal masses, but it does not correlate well with the perioperative outcomes of open partial nephrectomy (OPN). To overcome these shortcomings, a modified RNS (MRNS) has been proposed. In this study, we evaluated the MRNS and its role in predicting the perioperative outcomes of OPN.
This was a prospective observational study performed at a tertiary care hospital to evaluate the efficacy of MRNS in predicting the perioperative outcomes of OPN. Sixty-four cases were included in the study. Demographic parameters, tumor characteristics, and perioperative outcomes were analyzed. Correlation with the post-operative outcomes and the strengths of MRNS were compared with various other nephrometry scores.
The mean age of the patients was 52.89 years, 60.9% were male and 53.1% had a right-sided mass. The comorbidities, body mass index, and performance scores were evenly distributed across the complexity groups ( > 0.05). The mean tumor size was 4.13 cm and the mean MRNS and RNS were 9.45 and 6.1, respectively. 60.9% of the cases had no complications. Major complications (Clavien-Dindo grade [CDG] 3+) were noted in five cases (7.8%). The trifecta of neargin, ischemia, and complications (MICs) score was achieved in 85.9% and was achieved in 71.9% of the cases. MRNS was found to be an independent predictor of the trifecta outcomes ( = 0.04). Receiver-operating characteristic curve of MRNS analyzing the major complications as per the CDG showed an area under the curve of. 804, indicating good prediction of complications by the MRNS.
MRNS improves the predicting power of RNS by attributing enhanced scores to key elements and by adding new elements. Also, MRNS has good ability to predict the achievement of the trifecta and MIC.
肾计量评分（RNS）是一种对肾肿块复杂性进行分级的标准化系统，但它与开放性部分肾切除术（OPN）的围手术期结果相关性不佳。为克服这些缺点，人们提出了改良的RNS（MRNS）。在本研究中，我们评估了MRNS及其在预测OPN围手术期结果中的作用。
这是一项在三级医疗中心进行的前瞻性观察性研究，旨在评估MRNS在预测OPN围手术期结果中的有效性。该研究纳入了64例病例。分析了人口统计学参数、肿瘤特征和围手术期结果。将与术后结果的相关性以及MRNS的优势与其他各种肾计量评分进行了比较。
患者的平均年龄为52.89岁，60.9%为男性，53.1%的患者肿块位于右侧。合并症、体重指数和体能评分在不同复杂性组中分布均匀（>0.05）。平均肿瘤大小为4.13 cm，平均MRNS和RNS分别为9.45和6.1。60.9%的病例无并发症。5例（7.8%）出现严重并发症（Clavien-Dindo分级[CDG]3+）。85.9%的病例实现了切缘、缺血和并发症（MIC）三联征评分，71.9%的病例实现了该评分。发现MRNS是三联征结果的独立预测因素（=0.04）。MRNS根据CDG分析严重并发症的受试者工作特征曲线显示曲线下面积为0.804，表明MRNS对并发症有良好的预测能力。
MRNS通过对关键要素赋予更高分数并添加新要素，提高了RNS的预测能力。此外，MRNS具有良好的预测三联征和MIC实现情况的能力。
